Criss v. Union Security Insurance

26 F. Supp. 3d 1161, 2014 WL 2707774, 2014 U.S. Dist. LEXIS 79300
CourtDistrict Court, N.D. Alabama
DecidedJune 11, 2014
DocketCivil Action No. 2:13-cv-0685-WMA
StatusPublished
Cited by1 cases

This text of 26 F. Supp. 3d 1161 (Criss v. Union Security Insurance) is published on Counsel Stack Legal Research, covering District Court, N.D. Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Criss v. Union Security Insurance, 26 F. Supp. 3d 1161, 2014 WL 2707774, 2014 U.S. Dist. LEXIS 79300 (N.D. Ala. 2014).

Opinion

MEMORANDUM OPINION AND ORDER

WILLIAM-M. ACKER, JR., District Judge.

Prologue

This court devoutly wishes that the Supreme Court of the United States had not blindly stumbled off on the wrong foot and in the wrong direction when it handed down Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 109 S.Ct. 948, 103 L.Ed.2d 80 (1989), the case in which it invented a strange quasi-administrative regime for court review of denials of ERISA benefits claims. It inexplicably substituted a procedure borrowed from administrative law for the clear congressional man[1163]*1163date that the filing of a “civil action” (a simple, straight-forward, garden-variety suit for breach of contract) is the only means for challenging such denial decisions. In the amicus curiae brief filed by the Solicitor General in Bruch, he did his best to keep the Supreme Court from wandering off track and ignoring Congress. The Solicitor General, who was representing both Congress and the persons whom Congress intended to benefit from ERISA, failed to talk the Supreme Court out of its misguided step, a misstep that has led to a series .of further judicial glosses, distillations, penumbras, and emanations, eventuating in the sad state of affairs now faced by ERISA claimants and by the courts who have to deal with ERISA benefits claims.

If Congress itself had enacted the weird scheme created by the Bruch court out of whole cloth, ERISA would have been promptly and successfully attacked for its patent unconstitutionality as a violation of “due process”. A quick application of the universally recognized legal maxim, nemo judex in causa sua, would have kept any such statute off the statute books. Chief Justice Sir Edward Coke in Dr. Bonham’s Case, 8 Co. Rep. 107a, 77 Eng. Rep. 638 (C.P.1610), carved in granite for all time this fundamental jurisprudential principle when he said, using the vernacular: “No man should be a judge in his own case.”

The justices of the Supreme Court, including some who decided Bruch, routinely recuse themselves when there is even the slightest hint of any possible self-interest by the recusing justice. And yet, today, clearly conflicted ERISA plan administrators and insurers, when granted by the plan document that they drafted full discretion to interpret their plans and to decide the ultimate issue of entitlement, are routinely allowed, even required, to rule on their own cases. Not surprisingly, this court has not found a single case in which an insurance company has recused itself in an ERISA case under the rule of nemo judex in causa sua. There is no scheme remotely like the one created by Bruch in the annals of Anglo-American jurisprudence. Chief Justice Coke is uncomfortable in his crypt.

While in the above three paragraphs this court has been indulging in wishful thinking, the court is now brought back to earth by the knowledge that it cannot alter or ignore the actual state of ERISA jurisprudence, as it has evolved from Bruch. Especially, this court cannot alter or ignore what the Eleventh Circuit has done to produce its own sui generis brand of fruit from the poisoned tree.

In Brown v. Blue Cross & Blue Shield of Alabama, Inc., 898 F.2d 1556 (1990), the Eleventh Circuit acknowledged the binding effect of the Rrae/i-created “arbitrary and capricious” standard for reviewing the decisions of ERISA decision-makers who have granted themselves Bruch discretion. But, in Brown, the Eleventh Circuit also recognized that the Brack regime could lead to the Frankenstein that it has come to be. The Eleventh Circuit issued its warning to itself and to others, in the following remarkable, but unmistakable language:

Because we have restated the standard as arbitrary and capricious, the temptation exists to consult precedent regarding the use of that standard to review administrative agency decisions. See e.g., Jett [v. Blue Cross & Blue Shield of Alabama, Inc.], 890 F.2d [1137] at 1141-42 [ (11th Cir.1989) ] (Johnson. J., concurring and- dissenting) (citing and quoting from Motor Vehicle Mfrs. Ass’n v. State Farm Auto. Ins. Co., 463 U.S. 29, 103 S.Ct. 2856, 77 L.Ed.2d 443 (1983)). In some instances an overlap is evident.' Compare, e.g., id. (extracting duty to [1164]*1164investigate from- Motor Vehicle Mfrs. Ass’n) with Jader [v. Principal Mut. Life Ins. Co.], 723 F.Supp. [1338] at 1342-43 [ (D.Minn.1989) ]; Slover [v. Boral Henderson Clay Products, Inc.], 714 F.Supp. [825] at 832-33 [ (E.D.Tex.1989) ]; Teeter v. Supplemental Pension Plan, 705 F.Supp. 1089, 1095 (E.D.Pa.1989) (fiduciary has affirmative duty to gather information bearing on beneficiary’s claim that is reasonably obtainable). We express caution, however, at wholesale importation of administrative agency concepts into the review of ERISA fiduciary decisions. Use of the administrative agency analogy may, ironically, give too much deference to ERISA fiduciaries. Decisions in the ERISA context involve the interpretation of contractual entitlements; they “are not discretionary in the sense, familiar from administrative law, of decisions that make policy under a broad grant of delegated powers.” Van Boxel [v. Journal Co. Employees’ Pension Trust ], 836 F.2d [1048] at 1050 [ (7th Cir.1987) ]. Moreover, the. individuals who occupy the position of ERISA fiduciaries are less well-insulated from outside pressures than are deci-sionmakers at government agencies. See Maggard [v. O’Connell], 671 F.2d [568] at 571 [ (D.C.Cir.1982) ]. We therefore concentrate on the common law trust principles to evaluate the application of the arbitrary and capricious standard. Of course, the common law we consider includes the cases decided under the Labor Management Relations Act. See, e.g., Sharron v. Amalgamated Ins. Agency Servs., Inc., 704 F.2d 562 (11th Cir.1983) (decided under LMRA, not ERISA, but subsequently applied to ERISA situations).

Brown, 898 F.2d at 1564 n. 7. This ominous footnote did not slow down the Eleventh Circuit in its march toward achieving the reputation as the circuit court of appeals least likely to rule against a plan administrator or an insurer.

In response to Bruch, an increasing number of states have adopted a statute or insurance industry rule that precludes the inclusion of the so-called “discretionary clause” in a disability insurance policy. These states have wisely slipped the embrace of Bruch and have accomplished in their states what Congress intended, namely, trials de novo for beneficiaries after they have been denied and unsuccessfully exhausted their internal plan remedies. Alabama, Georgia, and Florida have not seen fit to take advantage of this means for escaping Bruch. Meanwhile, the Eleventh Circuit has created its “six-step” analysis, which puts plan administrators and insurers firmly in the driver’s Seat, and invites them to sit in judgment on their own denial decisions, and to ignore, as if meaningless, their fiduciary obligations of strict loyalty to their plan beneficiaries.

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26 F. Supp. 3d 1161, 2014 WL 2707774, 2014 U.S. Dist. LEXIS 79300, Counsel Stack Legal Research, https://law.counselstack.com/opinion/criss-v-union-security-insurance-alnd-2014.